Alberta-made Linac-MR machine combining MRI and radiation could revolutionize cancer treatments

A machine designed and built in Edmonton is being hailed as a medical breakthrough, expected to revolutionize the way cancer is fought.

“It’s not often you see in your career, an innovation where you can see a new technology that’s going to be able to change how you treat patients,” Dr. Nawaid Usmani said of the Linac-MR machine.

The technology is capable of delivering radiation while also simultaneously obtaining high-contrast and high-resolution magnetic resonance imaging (MRI) — providing the world’s most advanced radiation therapy for treatment of tumours.

It was a process once thought impossible in the science and medical community.

Usmani, an Alberta Health Services clinician and researcher, will be leading clinical trials of the machine at the Cross Cancer Institute in Edmonton, where the research took place before the machine was built.

“Starting next week, we’ll be treating our first patient and he’ll be a patient who can confirm that it’s safe and effective,” Usmani said.

“Since it was built and developed and created at the Cross, the Cross is doing all these clinical studies.”

Previously, a Linac (linear accelerator, the device most commonly used to deliver radiation treatments for patients with cancer) and an MRI had to be installed at least 10 metres apart because they interfered with one another.

The MRI machine’s magnetic field impedes the creation of X-rays and in turn, the Linac affects the operation of the magnetic resonance.

That meant before, patients had to be transferred from one machine to the other: during which tumours and organs could shift, and there would not be a real-time view of the tumour, thus healthy tissues around the tumour would also get radiation.

“The merging was one of the issues and till we did it, it was actually thought impossible to do that,” said Dr. Gino Fallone, the Cross Cancer Institute’s medical physics director.

Fallone, along with his team at the Cross Cancer Institute and University of Alberta, have been working for more than a decade on the Linac-MR hybrid machine.

“I think people in our field for many years have thought, if we could somehow get the ability of MRI during the time of treatment, it really would solve a lot of issues,” Fallone said.

Usmani said he became involved in the last five years as the process, which involved over 70-peer reviewed scientific papers on solving the physics and engineering, got closer to clinical trials.

“We’ve been working with (Fallone’s) team to help ensure that we can do things safely and effectively,” Usmani said.

Fallone said his team always expected the machine would work — but it took about 15 years of science and problem-solving to bring the concept to fruition: “It’s fun physics.”

The LMR can treat any type of cancer in the body and allows oncologists to deliver more precise radiation to tumours that move during treatment, or to tumours that are close to healthy organs that need to be avoided.

“We are hopeful that we can offer treatments that we currently can’t do,” Usmani said, explaining illnesses like pancreatic cancers are one type that usually struggle with traditional radiation.

“This type of technology will actually allow us to treat that effectively and give us better outcomes for those types of cancers.”

The LMR provides live, 3D imaging of cancer tumours and avoids healthy tissues during treatment.

That means even as a patient, for example, breathes  — the machine tracks the movement of the tumour inside the body and adjusts the radiation accordingly.

“Because we can treat many tumors more effectively, more precisely with this type of technology, and it’s not limited to one treatment site,” Usmani said.

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This more precise radiation can result in better tumour control and fewer side effects from radiation, allowing a higher dose to be used and in fewer sessions.

Fallone said the new technology could result in a 20 to 40 per cent improvement in cure rates.

“That’s why we are this field — to solve a problem, which was to improve cancer cure rates. This will do that significantly, with less side effects.”

The first patient to slide inside the machine next week will be 85-year-old Marvin Bahry. He first was diagnosed with prostate cancer more than a dozen years ago and is experiencing a relapse.

“I can’t believe it. I’m just so thrilled and grateful and I think some wonderful things are going to come as a result of this,” Bahry said.

Usmani said the goal is to start using the true innovations of the machine a year from now.

“We’ll start offering it to patients who could really benefit from this machine: patients with prostate cancers, pancreatic cancers, breast cancers, liver tumors, head and neck tumors.”

Usmani said the plan is to treat about 100 patients for each of those sites over the next few years.

“The beauty of this machine is, radiation can be given to any solid tumor.

“So we can treat any cancer and the impact of this machine will be very significant for that reason.”

AHS said the Northern LIGHTS clinical trials done with the Linac-MR is a collection of seven distinct trials. The goal is to reduce treatment sessions, improve patient experience and patient outcomes, as healthy tissues will not be targeted by the radiation.

Northern LIGHTS 1 (imaging only) started in 2022 and has accrued 40 patients.

Northern LIGHTS 2 (first-in-human treatments) will start treatment next week and will accrue approximately 100 patients over the next year.

The other five trials are expected to start in 2024 and will likely accrue 100 patients each, and will focus on those with the following cancers:

• Prostate
• Tumours in the lungs or liver
• Head and neck
• Breast
• Other tumours that will benefit from the Linac-MR

Funding for the machine was provided by the Alberta Cancer Foundation, Alberta Innovates, Western Economic Diversification (Canada), now called PrairiesCan, and Canadian Institutes of Health Research, as well as direct and in-kind investments by Cancer Care Alberta (CCA).

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